Cost-Utility and Cost-Effectiveness Analyses of Face-to-Face Versus Telephone-Based Nonpharmacologic Multidisciplinary Treatments for Patients With Generalized Osteoarthritis

Abstract

OBJECTIVE: To evaluate, from a societal perspective, the cost utility and cost effectiveness of a nonpharmacologic face-to-face treatment program compared with a telephone-based treatment program for patients with generalized osteoarthritis (GOA). METHODS: An economic evaluation was carried out alongside a randomized clinical trial involving 147 patients with GOA. Program costs were estimated from time registrations. One-year medical and nonmedical costs were estimated using cost questionnaires. Quality-adjusted life years (QALYs) were estimated using the EuroQol (EQ) classification system, EQ rating scale, and the Short Form 6D (SF-6D). Daily function was measured using the Health Assessment Questionnaire (HAQ) disability index (DI). Cost and QALY/effect differences were analyzed using multilevel regression analysis and cost-effectiveness acceptability curves. RESULTS: Medical costs of the face-to-face treatment and telephone-based treatment were estimated at euro387 and euro252, respectively. The difference in total societal costs was nonsignificantly in favor of the face-to-face program (difference euro708; 95% confidence interval [95% CI] -euro5,058, euro3,642). QALYs were similar for both groups according to the EQ, but were significantly in favor of the face-to-face group, according to the SF-6D (difference 0.022 [95% CI 0.000, 0.045]). Daily function was similar according to the HAQ DI. Since both societal costs and QALYs/effects were in favor of the face-to-face program, the economic assessment favored this program, regardless of society's willingness to pay. There was a 65-90% chance that the face-to-face program had better cost utility and a 60-70% chance of being cost effective. CONCLUSION: This economic evaluation from a societal perspective showed that a nonpharmacologic, face-to-face treatment program for patients with GOA was likely to be cost effective, relative to a telephone-based program.